Cataract refractive surgery: Innovative technology provides more choices for Canadian cataract patients.

Historically, cataract surgery was aimed at removing the clouded lens of the eye and replacing it with an artificial lens; this provided clear vision to patients but without regard to their refractive error-their need for spectacles or contact lenses after surgery. Modern diagnostic and surgical instrumentation now makes it possible to address these refractive errors at the time of surgery, introducing a new paradigm-cataract refractive surgery. Although not medically necessary, many patients appreciate the chance to reduce or eliminate their need for spectacles after surgery, even if some personal cost is involved.

La chirurgie réfractive de la cataracte: des technologies novatrices élargissent les choix des patients canadiens.

La chirurgie de la cataracte a toujours consisté à extraire le cristallin opacifié de l'œil pour le remplacer par une lentille artificielle. Cette intervention rend la vision du patient plus nette, sans pour autant corriger l'erreur de réfraction, c'est-à-dire la nécessité de porter des lunettes ou des lentilles cornéennes après l'opération. Les instruments diagnostiques et chirurgicaux modernes permettent désormais de corriger ces erreurs de réfraction au moment de l'opération, ce qui a fait émerger une nouvelle notion, celle de la chirurgie réfractive de la cataracte. Même si cette correction n'est pas nécessaire sur le plan médical, de nombreux patients se réjouissent de la possibilité de ne plus porter de lunettes ou d'en porter moins après l'opération, même s'ils doivent engager des frais.

Customizing Clinical Outcomes with Implantation of Two Diffractive Trifocal IOLs of Identical Design but Differing Light Distributions to the Far, Intermediate and Near Foci.

Purpose: To evaluate clinical outcomes after bilateral or contralateral implantation of the Gemetric™ (G) and Gemetric™ Plus (GPlus) diffractive trifocal intraocular lenses (IOLs). Methods: This was a prospective, randomized, multi-center open-label study comparing clinical results and subjective patient responses around 6 months after implantation of the study lenses (toric and non-toric) in three different groups (bilateral G, bilateral GPlus and contralateral G/GPlus implantation). Results included the manifest refraction, uncorrected and distance corrected monocular and binocular visual acuity (VA) at distance, intermediate and near; the defocus curve; contrast sensitivity; and patient reported outcomes regarding spectacle independence, satisfaction and visual disturbances. Results: There was no statistically significant difference in the mean refraction spherical equivalent between the two lens models (p = 0.33) or between the toric and non-toric lenses (p = 0.06). Monocular VA was better at distance with the G lens and better at near with the GPlus lens (p < 0.01). Mean binocular VA was better than 0.1 logMAR at all distances for all groups, both uncorrected and distance corrected. The mean binocular distance corrected VA was better than 0.15 logMAR from 0.0 D to -3.50 D for all groups. All VA data for the contralateral group was as good or better than for the bilateral GPlus group. Questionnaire results showed no difference between groups for the frequency, severity, or degree of bother of visual disturbances (p > 0.24). Conclusion: The two diffractive trifocal IOLs studied here may be used either bilaterally or contralaterally for the correction of presbyopia in cataract patients, providing excellent visual acuity with low levels of visual disturbances and high rates of overall spectacle independence. Bilateral Gemetric implantation resulted in slightly better distance and intermediate vision while contralateral implantation provided slightly better near vision. There was no apparent advantage to implanting the GPlus IOL bilaterally.

Effect of Artificial Tears on Preoperative Keratometry and Refractive Precision in Cataract Surgery.

Purpose: The primary objective was to investigate if treatment with artificial tears affected the variability of keratometry measurements for subjects with dry eyes prior to cataract surgery. The secondary objectives were to investigate whether treatment with artificial tears improved refractive precision and whether subjects with non-dry eyes had better refractive precision than subjects with dry eyes. Design: Prospective randomized controlled trial with three arms. Patients and methods: Dry eye diagnostics according to DEWS II were performed, and subjects with dry eyes were randomized to no treatment (group A1) or treatment with artificial tears two weeks prior to cataract surgery (group A2), with the third group (Group B, non-dry eyes) as a control. Keratometry was performed twice at baseline and twice after two weeks at the time of cataract surgery with three different optical biometers. The change in mean variability of keratometry (average K and magnitude of vector differences) and percentages of outliers after two weeks versus baseline were compared for group A2. The refractive and astigmatism prediction errors were calculated eight weeks after cataract surgery and compared for all three groups. Results: One hundred thirty-one subjects were available for analysis. There was no statistically significant difference in the mean variability of keratometry or percentages of outliers for group A2 from baseline to the time of cataract surgery. There was no statistically significant difference in refractive precision (absolute error and astigmatism prediction error) between any groups. Conclusion: Subjects with dry eyes (treated and non-treated) achieved the same refractive precision and percentages of outliers as subjects with non-dry eyes. Treatment with artificial tears for two weeks appeared inadequate to significantly affect variability in biometric measurements for patients with dry eyes prior to cataract surgery. DEWS II criteria for DED may not be optimal in a cataract setting.

The Significance of Dry Eye Signs on Preoperative Keratometry Measurements in Patients Scheduled for Cataract Surgery.

Purpose: The primary objective was to investigate if subjects with dry eyes had increased variability of keratometry measurements prior to cataract surgery compared to subjects with non-dry eyes. Secondary objectives were to determine which separate signs affected keratometry. Patients and Methods: This study was part of a prospective interventional randomized controlled trial. After dry eye diagnostics were performed (signs only) subjects were divided into sign of dry eye (SDE) positive and negative groups. To investigate variability, we performed two keratometry measurements for each subject with three different optical biometers: Anterion (OCT optical biometer), Eyestar (combined OCT and reflection-based optical biometer), and Lenstar (reflection based-optical biometer). Results: One hundred and thirty-one subjects were available for analysis. The variability of astigmatism was significantly higher for subjects with hyperosmolarity compared to normal eyes for the Lenstar, as was the percentage of eyes with variability of astigmatism greater than 0.25 D. The percentage of eyes with variability of average K greater than 0.25 D was higher for subjects with non-invasive keratograph break-up time <10 seconds (NIKBUT positive) compared to normal eyes for the Lenstar. Conclusion: Combined diagnostic criteria (signs only) showed no statistically significant differences for keratometry measurements between SDE positive and negative. Eyes with hyperosmolarity and NIKBUT positive showed statistically higher variability of keratometry measurements compared to normal eyes for Lenstar, but not for the Anterion or Eyestar biometers.

Clinical performance after implantation of an EDOF intraocular lens in the dominant eye and a presbyopia-correcting intraocular lens in the nondominant eye.

PURPOSE: To evaluate subjective and objective outcomes after combined implantation of an extended depth-of-focus (EDOF) intraocular lens (IOL) and a combined technology multifocal lens (CT-IOL). SETTING: 2 clinical practices (Carolina Eyecare Physicians, Center For Sight) in the United States. DESIGN: Prospective, unmasked, multicenter, nonrandomized bilateral eye study. METHODS: Patients interested in reducing their dependence on spectacles were implanted with an EDOF IOL in the dominant eye and a CT-IOL in the nondominant eye. Refractive and visual acuity (VA) data at various distances (4 m, 66 cm, 40 cm, and 33 cm) were collected 3 months postsurgery, along with the distance-corrected binocular defocus curve and responses to questionnaires related to spectacle independence, visual disturbances, and overall visual function. RESULTS: Data from 37 participants were analyzed. The distance-corrected binocular defocus curve showed a mean VA better than 0.1 logMAR (20/25) at all vergences from +1.00 to -2.50 diopters (D). 36 participants (97%) had an uncorrected binocular VA of 0.3 logMAR or better, at all test distances. 70% of participants (26/37) reported never wearing spectacles at any distance, and 84% (31/37) were "completely" or "mostly" satisfied with their overall vision after surgery. Halos were the disturbance reported most frequently and reported as most bothersome, with difficulty driving at night the most common visual function issue. Difficulty reading was the next most reported issue. Overall eyesight was rated as "excellent" or "good" by 92% (34/37) of participants. CONCLUSIONS: This combined EDOF/CT-IOL approach was well-tolerated by participants and provided some potential benefits relative to bilateral implantation of either lens.

Prospective multicenter study of toric IOL outcomes when dual zone automated keratometry is used for astigmatism planning.

PURPOSE: To evaluate clinical outcomes when toric intraocular lens (IOL) calculations are based on the keratometric output from the Lenstar LS-900 dual zone automated keratometer (Haag-Streit AG, Koeniz, Switzerland). METHODS: Eligible subjects presenting for toric IOL implantation at five sites were measured with a dual-zone automated keratometer. The data were used to plan the power and angle of the toric IOL to be implanted. Refractive and visual acuity status were checked at 1 and 3 months postoperatively. RESULTS: A total of 102 eyes had relevant data for analysis. More than 76% of eyes had 0.50 diopter or less of refractive astigmatism at 1 and 3 months, with no difference by level of astigmatism corrected. More than half of the eyes had uncorrected distance visual acuity of 20/20 or better and 78% were 20/25 or better. A new measure of effectiveness of toric correction power is described that suggested lens selection was appropriate. Results appeared better than those obtained in previous studies when the IOL cylinder power and alignment were calculated using manual keratometry. CONCLUSIONS: In this series of eyes from multiple centers, the calculation of toric IOL power using dual-zone automated keratometry measurements produced clinical results that were better than results in the literature where manual keratometry was used.

Visual outcomes, satisfaction, and spectacle independence with a nondiffractive extended vision intraocular lens targeted for slight monovision.

PURPOSE: To evaluate vision, satisfaction, and spectacle independence of the AcrySof IQ Vivity intraocular lens when the nondominant eye is targeted for slight myopia. SETTING: 1 clinical practice in the United States. DESIGN: Prospective unmasked nonrandomized clinical trial. METHODS: Patients presenting for cataract surgery interested in reducing their dependence on spectacles were enrolled, with the dominant eye targeted for emmetropia and the nondominant eye targeted for slight monovision (-0.50 diopters [D]). Visual disturbances, satisfaction, and spectacle independence were evaluated. Visual acuity (VA) was tested at distance (4 m), intermediate (66 cm), and near (40 cm) at 3 months postoperatively when uncorrected, with both eyes corrected to emmetropia and with 1 eye adjusted for monovision. 2 binocular defocus curves were also collected under the latter 2 conditions. RESULTS: Data from 31 patients were analyzed. The mean refractive spherical equivalent was 0.45 D more myopic in the nondominant eye, resulting in worse uncorrected VA at distance but better uncorrected VA at near. The binocular defocus curve with monovision showed significantly better VA from -2.0 to -3.0 D, and patients reported less need for spectacles (and better vision) at near than reported with binocular emmetropia. Glare, blurred vision, and starbursts were the most reported visual disturbances. Although not correlated with the difference in refraction, glare and blurred vision were significantly correlated with overall satisfaction. CONCLUSIONS: Implanting this IOL with a target of slight myopia in the nondominant eye appears to be a viable way to improve near vision, although with an increased potential for visual disturbances.

Comparing Visual Performance and Subjective Outcomes with an Enhanced Monofocal Intraocular Lens When Targeted for Emmetropia or Monovision.

Purpose: To evaluate relative visual performance and subjective outcomes after implantation of the TECNIS Eyhance™ intraocular lens (IOL) targeted for bilateral emmetropia or monovision. Methods: This was a prospective, single-center randomized, patient-masked trial. Patients were implanted with the enhanced IOL targeted for bilateral emmetropia or slight monovision (-0.75 D in the non-dominant eye). At 3 months the binocular visual acuity (VA) was measured at distance, intermediate and near, along with low contrast VA in photopic and mesopic conditions, and the distance corrected defocus curve. Questionnaires related to spectacle independence, satisfaction, visual symptoms, and functional vision were administered. Results: Data from 71 subjects (34 Emmetropia, 37 Monovision) were analyzed. There was no difference in the mean uncorrected distance VA (p = 0.11), but uncorrected intermediate and near VAs were one line better in the Monovision group (p = 0.02 and 0.01, respectively). Mesopic and photopic low contrast VA were similar between groups. There was a trend for less difficulty and higher satisfaction with near and intermediate vision in the Monovision group, but no significant differences in any of the subjective questionnaires. Difficulty reading was the most reported concern in both groups, though 93% of all subjects reported "little" or "no" difficulty with daily activities. Overall, 82% of subjects were "completely" or "very" happy with their lens choice. Conclusion: Using this enhanced IOL with slight monovision in the non-dominant eye increased intermediate and near VA with no apparent effect on low contrast distance VA, subjective visual quality, or satisfaction.

Visual Outcomes, Quality of Vision, Patient Satisfaction and Spectacle Independence After Bilateral Implantation of the Synergy™ Intraocular Lens.

Purpose: To evaluate vision, visual quality, patient satisfaction and spectacle independence after bilateral implantation of the TECNIS Synergy™ intraocular lens. Setting: Two clinical practices in the USA. Design: Ambispective unmasked non-randomized clinical trial. Methods: Patients with a history of uneventful bilateral femtosecond laser assisted cataract surgery with the study IOL implanted, targeted for emmetropia, at least 3 months prior to the study visit were enrolled. Monocular and binocular visual acuity (VA) were measured at distance, intermediate and near, along with binocular mesopic VA. Low contrast binocular VA and reading speed in mesopic and photopic conditions were also measured. Patient satisfaction, spectacle independence, visual symptoms, and functional vision questionnaires were completed. Results: Results from 52 subjects were available for analysis. Mean binocular unaided visual acuity was ~0.1 logMAR (20/20) from distance to 33 cm, with 81% of subjects having 0.2 logMAR (20/25) vision or better at all test distances and 92% reporting never needing glasses at any distance. Average reading speed at 40 cm was only 10 words/minute slower in dim light (p = 0.03). Mesopic and low contrast acuity appeared good. Halos were the most frequent and bothersome visual disturbances, with the greatest effect on driving at night. Eighty-eight percent of subjects reported being "completely" or "mostly" satisfied with their overall unaided vision. Conclusion: This hybrid technology IOL provided a range of binocular visual acuity from distance to 33 cm and good functional vision, even in dim light. Patients should be advised of the likelihood of visual disturbances, particularly halos.

Prospective study of toric IOL outcomes based on the Lenstar LS 900® dual zone automated keratometer.

BACKGROUND: To establish clinical expectations when using the Lenstar LS 900® dual-zone automated keratometer for surgery planning of toric intraocular lenses. METHODS: Fifty eyes were measured with the Lenstar LS 900® dual-zone automated keratometer . Surgical planning was performed with the data from this device and the known surgically induced astigmatism of the surgeon. Post-operative refractions and visual acuity were measured at 1 month and 3 months. RESULTS: Clinical outcomes from 43 uncomplicated surgeries showed an average post-operative refractive astigmatism of 0.44D ±0.25D. Over 70% of eyes had 0.50D or less of refractive astigmatism and no eye had more than 1.0D of refractive astigmatism. Uncorrected visual acuity was 20/32 or better in all eyes at 3 months, with 70% of eyes 20/20 or better. A significantly higher number of eyes had 0.75D or more of post-operative refractive astigmatism when the standard deviation of the pre-operative calculated corneal astigmatism angle, reported by the keratometer, was > 5 degrees. CONCLUSIONS: In this single-site study investigating the use of the keratometry from the Lenstar LS 900® for toric IOL surgical planning, clinical outcomes appear equivalent to those reported in the literature for manual keratometry and somewhat better than has been reported for some previous automated instruments. A high standard deviation in the pre-operative calculated astigmatism angle, as reported by the keratometer, appears to increase the likelihood of higher post-operative refractive astigmatism.

Refractive and Visual Outcomes After Implantation of a Secondary Sulcus Intraocular Lens with an Extended Depth of Focus.

Purpose: To evaluate the range of vision, visual function, and quality of vision after implantation of a secondary extended depth of focus intraocular lens (EDOF IOL) implanted in the sulcus. Setting: One clinical practice in Haugesund, Norway. Design: Prospective single arm non-interventional study. Methods: Eligible subjects presenting for surgery, or who had previous successful primary cataract or refractive lens exchange surgery in both eyes were subsequently implanted with the AddOn® secondary EDOF IOL in the sulcus. Manifest refraction and visual acuity at distance, intermediate and near were measured 3 months after surgery, along with the monocular defocus curve. Subjects also completed a visual function and a quality of vision questionnaire. Results: The study included 32 eyes of 16 subjects. At 3 months postoperative, the mean refraction spherical equivalent (MRSE) was -0.16 ± 0.30 D, with a residual cylinder of 0.29 ± 0.27 D. The mean monocular uncorrected VA was 0.1 logMAR (20/25) or better at all test distances. The monocular defocus curves showed a depth of focus of 2.0 D. For every category except reading fine print, all but one subject (94%) had no difficulty or little difficulty with near tasks. Glare and halos were the most common visual disturbances, with no reports of starbursts. There was no evidence of any intralenticular opacification in any of the eyes, and no evidence of iris chafing/depigmentation. Conclusion: This secondary EDOF IOL provided excellent distance and intermediate vision, and very good near vision to subjects. Subject reported near visual function was also very good and visual disturbances were limited. This lens appears to be a good option for patients who would like to improve their range of vision. Results appear as good or better than those reported for primary EDOF lenses.

Evaluation of Quality of Vision and Visual Outcomes with Bilateral Implantation of a Non-Diffractive Extended Vision Intraocular Lens with a Target of Slight Myopia in the Non-Dominant Eye.

PURPOSE: To assess the visual outcomes and quality of vision of patients receiving the AcrySof® IQ Vivity™ non-diffractive extended vision intraocular lens (NDEV IOL) after uneventful cataract surgery when the non-dominant eye is targeted for slight myopia. DESIGN: Single site, prospective, single-arm study. METHODS: Eligible subjects interested in reducing their dependence on spectacles over a range of working distances were enrolled and followed for 3 months after the second eye surgery. Subjects were bilaterally implanted with this NDEV IOL, with a target of emmetropia in the dominant eye and a myopic refraction of -0.75D in the non-dominant eye. At 3 months postoperative, the uncorrected and distance-corrected (with monovision) visual acuity at 40 cm, 66 cm and 4 m were recorded, along with the manifest refraction. Questionnaires related to spectacle independence, patient satisfaction and quality of vision were also administered. RESULTS: Data from 33 subjects were analyzed. The mean difference between eyes by subject was 0.80 ± 0.37 D. Twenty-nine of 33 (88%) subjects had a binocular uncorrected near VA of 0.2 logMAR or better. Twenty-five of 33 eyes (76%) had a binocular distance-corrected (-0.75 D in the non-dominant eye) VA of 0.2 logMAR or better at all three test distances. Satisfaction with vision at all distances was high. The reported level of spectacle independence was higher than for the same lens without monovision. Visual disturbances were higher than has been previously reported for this lens but were not correlated to the level of monovision. CONCLUSION: A target of -0.75 D of myopia in the non-dominant eye of patients bilaterally implanted with this NDEV IOL improved near vision, increasing the rate of spectacle independence in patients relative to those targeted for bilateral emmetropia, with no correlated increases in visual disturbances.

The Effects of Angle Kappa on Clinical Results and Patient-Reported Outcomes After Implantation of a Trifocal Intraocular Lens.

Purpose: To objectively determine if angle kappa materially influenced clinical outcomes or patient-reported satisfaction and visual quality of patients implanted with a trifocal intraocular lens (IOL). Methods: This was a non-interventional study of clinical outcomes. Subjects were patients choosing to be bilaterally implanted with a trifocal IOL (PanOptix®) who were then evaluated 3 months postoperative. Angle kappa (AK) was measured before surgery and at the 3-month visit. The 3-month visit included a manifest refraction, and measurement of uncorrected and distance corrected acuity at 4 m, 60 cm and 40 cm. Visual quality and satisfaction questionnaires were also administered. Results: Data from 56 eyes of 28 subjects were analyzed; 26 eyes had an AK magnitude <0.3 mm, 14 had an AK from 0.3 mm to less than 4 mm and 16 had an AK ≥0.4 mm. Neither visual disturbances (eg, glare, halos, starbursts), satisfaction nor spectacle dependence were correlated to the magnitude of angle kappa. The magnitude of postoperative AK was significantly lower than preoperative (0.24 ± 0.12 mm vs 0.30 ± 0.16 mm, p < 0.01). Conclusion: The magnitude of preoperative Angle Kappa had no apparent effect on the refractive, visual acuity or subjective (visual disturbances, quality of vision, satisfaction) clinical outcomes with this trifocal IOL. The magnitude of angle kappa was significantly lower after surgery.

Efficacy of a Secondary Trifocal Sulcus IOL in Providing Near and Intermediate Vision in Patients with Prior Myopic Laser Vision Correction and Cataract Surgery.

Purpose: To evaluate the visual function of patients with a history of prior laser vision correction and cataract surgery with implantation of a monofocal primary IOL after subsequent implantation of a secondary sulcus trifocal intraocular lens (IOL). Setting: One clinical practice in Haugesund, Norway. Design: Prospective, single arm, non-interventional unmasked study. Methods: Eligible subjects who had previous laser vision correction and cataract surgery involving implantation of a monofocal IOL in the capsular bag of one or both eyes were subsequently implanted with a secondary IOL in the sulcus. Postoperative uncorrected and best distance-corrected visual acuities (VAs) were measured at distance (4 m), intermediate (60 cm), and near (40 cm), along with low contrast visual acuity and the monocular distance corrected defocus curve. Results: Twenty-five eyes were evaluated from 7 to 24 months after trifocal implantation. The mean monocular uncorrected VAs were 0.06, 0.21 and 0.10 logMAR at distance, intermediate and near, respectively. Uncorrected near VA was 0.2 logMAR or better in 80% of eyes (20/25). VA of 0.2 logMAR or better at all test distances was achieved in 15/25 eyes (60%) in the uncorrected state and 17/25 eyes (68%) when corrected for distance vision. Binocular uncorrected distance visual acuity was 0.1 logMAR or better in all subjects while binocular uncorrected near visual acuity was 0.1 logMAR or better in all but one subject. The defocus curve showed a range of functional vision from distance to 30 cm. No adverse events were identified. Conclusion: The trifocal sulcus IOL provided excellent distance and near vision and a good range of functional vision, similar to results obtained when a primary trifocal IOL is implanted. It is a viable option to provide better intermediate and near vision to patients with a prior history of refractive surgery and a monofocal IOL implanted.

Comparison of refractive and visual acuity results after Contoura® Vision topography-guided LASIK planned with the Phorcides Analytic Engine to results after wavefront-optimized LASIK in eyes with oblique astigmatism.

PURPOSE: To compare visual acuity and refractive results between topography-guided laser in situ keratomileusis (LASIK) planned with the Phorcides Analytic Engine (PAE) to results after wavefront-optimized (WFO) LASIK in subjects with preoperative oblique astigmatism in their manifest refraction. METHODS: This was a retrospective chart review of clinical results from eyes treated with topography-guided LASIK planned with PAE compared to eyes treated with WFO LASIK using the same Wavelight® excimer laser system. All included subjects had preoperative oblique astigmatism. Residual refractive error and visual acuity (uncorrected and corrected) were the measures of interest, at the visit closest to 90 days postoperative. RESULTS: A matched data set from 100 WFO and 97 PAE eyes was extracted from clinical records. At the postoperative visit the PAE group showed lower residual refractive cylinder (p = 0.04), uncorrected distance visual acuity (UDVA) (-0.06 PAE vs. -0.02 WFO, p < 0.01) and distance corrected visual acuity (CDVA) (p < 0.01). The percentage of eyes with a mean refraction spherical equivalent (MRSE) magnitude within 0.25 D and 0.50 D of plano was statistically significantly higher in the PAE group (p = 0.04 and 0.01, respectively). A statistically significantly higher percentage of eyes in the PAE group had UDVA better than or equal to -0.10 logMAR (20/16 Snellen, 36% vs 22%, p = 0.04). More eyes gained CDVA after surgery in the PAE group (53% vs 32%, p < 0.01). There were five enhancements in the WFO group versus none in the PAE group, a statistically significant difference (p = 0.03). CONCLUSIONS: Visual acuity and refractive outcomes after LASIK using PAE in eyes with oblique astigmatism in their preoperative refraction were statistically significantly better than those obtained when WFO treatment was used. The number of refractive outliers and the number of retreatments were also significantly lower with PAE treatment.

Clinical and refractive outcomes after topography-guided refractive surgery planned using Phorcides surgery planning software.

PURPOSE: To evaluate prospectively the clinical outcomes of topography-guided laser in situ keratomileusis (LASIK) surgery performed with Contoura Vision using the Wavelight excimer laser and planned with the Phorcides Analytical Engine. SETTING: Four clinical practices in the U.S. DESIGN: Prospective single-arm interventional study. METHODS: 130 eyes of 65 patients with myopia or myopic astigmatism were enrolled in a prospective study of visual and refractive outcomes after treatment with Contoura Vision using the Wavelight EX500 excimer laser to achieve optimal distance vision. At 3 months postoperatively, uncorrected distance visual acuity (UDVA), manifest refraction, and corrected distance visual acuity (CDVA) were measured and compared with previously published studies. RESULTS: At 3 months postoperatively, 100%, 89%, and 28% of eyes achieved UDVA of 20/20, 20/15, and 20/12.5 or better, respectively. 92% of eyes had postoperative UDVA equal to or better than their preoperative CDVA. Postoperative CDVA was equal to, 1 line better, or 2 lines better than the preoperative CDVA in 53%, 40%, and 6% of eyes, respectively. Only 1 eye lost 1 line of CDVA, and no eyes lost more than 1 line of CDVA. A statistically significant decrease was noted in subjective visual complaints, including glare, halos, difficulty driving at night, reading difficulty, starbursts, fluctuation in vision, and light sensitivity. CONCLUSIONS: The Phorcides Analytical Engine can be used to optimize visual outcomes for the correction of myopia and myopic astigmatism.

Reported Patient Satisfaction and Spectacle Independence Following Bilateral Implantation of the PanOptix® Trifocal Intraocular Lens.

PURPOSE: To assess the spectacle independence and satisfaction of subjects after bilateral implantation of the PanOptix® trifocal intraocular lens (IOL) at the time of cataract surgery. DESIGN: Single site, prospective, single-arm study. METHODS: Eligible subjects interested in a trifocal IOL to potentially reduce dependence on spectacles for near, intermediate and distance vision were enrolled and followed for 3 months after the second eye surgery. Visual acuity and refractive data were collected 1 month and 3 months postoperative, including the uncorrected and best distance-corrected binocular visual acuities at distance (4m), intermediate (60 cm) and near (40cm). A patient satisfaction and spectacle independence questionnaire were administered at the 3-month visit. RESULTS: A total of 30 subjects successfully completed the study. Eighty-five percent of eyes (51/60) had a refraction within 0.50 D of plano with ≤ 0.50 D of refractive cylinder. One subject (3%) reported needing glasses for distance work, 3 (10%) for intermediate work and 4 (13%) for near work. Ninety percent or more of all subjects reported never wearing glasses or wearing them only a little at all working distances. Ninety percent or more were able to function without glasses at all 3 working distances all or most of the time. More than ninety percent of subjects reported being "com.pletely" or "mostly" satisfied with their vision without glasses or contact lenses at all three distances and overall. CONCLUSION: A high percentage of patients are likely to achieve spectacle independence for distance, intermediate and near vision with this trifocal IOL.

Spectacle Independence and Quality of Vision After Bilateral Implantation of a Trifocal Intraocular Lens.

PURPOSE: To evaluate the patient-reported spectacle independence and quality of vision for patients who were bilaterally implanted with a trifocal intraocular lens (IOL). DESIGN: Single site, prospective, single-arm study. METHODS: Subjects presenting for cataract surgery who had an interest in reducing their dependence on glasses at multiple distances were enrolled. Subjects were bilaterally implanted with a trifocal IOL and followed for 3 months post-surgery. A spectacle independence questionnaire and a quality of vision questionnaire were administered at the 3-month visit. The binocular visual acuity at distance (4 m), intermediate (60 cm) and near (40 cm) was also measured in the uncorrected and distance-corrected state. RESULTS: All but one subject reported no need for glasses for distance and intermediate work, and most (25/29) reported no need for glasses for near work. Almost all subjects reported never wearing glasses or wearing them only a little, and being able to function without glasses at any distance all or most of the time. Ninety percent of subjects (26/29) reported being completely or mostly satisfied with their vision overall, without the use of glasses or contact lenses. The mean binocular visual acuity 1 and 3 months after surgery was better than 0.1 logMAR (20/25) at all test distances in both the uncorrected and distance-corrected states. The reported quality of vision appeared similar to previously reported data for the same IOL. CONCLUSION: The trifocal IOL provided nearly all subjects with functional vision and spectacle independence for distance, intermediate and near work. It is a viable alternative for patients looking to reduce their overall dependence on spectacles after cataract surgery.

Clinical Outcomes and Quality of Vision Associated with Bilateral Implantation of a Wavefront Shaping Presbyopia Correcting Intraocular Lens.

PURPOSE: To provide normative visual acuity and quality of vision data related to bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens (IOL). PATIENTS AND METHODS: This was a non-interventional research study of the refraction, visual acuity (VA) and quality of vision achieved after bilateral implantation of a wavefront shaping presbyopia correcting intraocular lens between 3 months and 12 months post-surgery. The manifest refraction, and uncorrected and distance corrected VA at near, intermediate and distance (40 cm, 50 cm, 66cm, 4 m) were tested. Binocular mesopic VA at 4m and uncorrected photopic low contrast (25%) VA at 4 m were also tested, the latter with and without a glare source. A patient reported outcome questionnaire was administered. Defocus curve testing with and without simulated myopia in the non-dominant eye was also tested (reported elsewhere). RESULTS: Forty subjects completed the study. There was no statistically significant difference between the uncorrected and distance corrected VA at any distance. Mean logMAR binocular VAs were (-0.07 ± 0.07) at 4 m, (0.00 ± 0.07) at 66 cm and (0.07 ± 0.11) at 40 cm. Uncorrected photopic low contrast VA was statistically significantly better without glare (0.09 ± 0.10) compared to with glare (0.44 ± 0.21, p < 0.01). Reported glare, halos and starbursts were "not at all" Or "a little" bothersome for more than 95% of subjects. Hazy vision and blurred vision were reported most often. CONCLUSION: The Vivity IOL provided patients with good distance and intermediate vision, and functional near vision with low reported bother from glare, halos, or starbursts.